Is the biology of breast cancer in Africa changing?

Background: Incidence of breast cancer (BC) is increasing in Africa, with higher case-mortality compared to non-African settings. Prior studies have shown that BC in Africa has a much higher proportion of estrogen-receptor (ER) negative and triple negative (TN) cancers, subsets with poorer prognosis regardless of the setting. However, there is growing evidence that these differences may partly be attributed to prior study designs and resources.Objectives: To determine the status of hormone receptor ER, PR and growth factor Her2 status on breast cancer.Design: A prospective study.Setting: Histopathology and immunohistochemistry laboratary at Moi Teaching and Referral HospitalSubjects: Tissue specimens from 100 breast cancer patients.Results: Patients mean age at the time of diagnosis was 45 years, 98% of cases were in women, 90% were infiltrating ductal carcinoma, and the majority were poorly differentiated. Sixty-two percent were ER positive 44% were PR positive and 22% were Her-2 /neu . Twenty-four percent of cases were TN.Conclusion: With improved access to in-country reliable IHC, our study supports the growing data that African breast cancer is not radically biologically different from breast cancers outside Africa

Measurement of the B0-anti-B0-Oscillation Frequency with Inclusive Dilepton Events

The $B^0$-$\bar B^0$ oscillation frequency has been measured with a sample of 23 million \B\bar B pairs collected with the BABAR detector at the PEP-II asymmetric B Factory at SLAC. In this sample, we select events in which both B mesons decay semileptonically and use the charge of the leptons to identify the flavor of each B meson. A simultaneous fit to the decay time difference distributions for opposite- and same-sign dilepton events gives $\Delta m_d = 0.493 \pm 0.012{(stat)}\pm 0.009{(syst)}$ ps$^{-1}$.Comment: 7 pages, 1 figure, submitted to Physical Review Letter

Measurement of the CP-Violating Asymmetry Amplitude sin2β\beta

We present results on time-dependent CP-violating asymmetries in neutral B decays to several CP eigenstates. The measurements use a data sample of about 88 million Y(4S) --> B Bbar decays collected between 1999 and 2002 with the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We study events in which one neutral B meson is fully reconstructed in a final state containing a charmonium meson and the other B meson is determined to be either a B0 or B0bar from its decay products. The amplitude of the CP-violating asymmetry, which in the Standard Model is proportional to sin2beta, is derived from the decay-time distributions in such events. We measure sin2beta = 0.741 +/- 0.067 (stat) +/- 0.033 (syst) and |lambda| = 0.948 +/- 0.051 (stat) +/- 0.017 (syst). The magnitude of lambda is consistent with unity, in agreement with the Standard Model expectation of no direct CP violation in these modes

Cervical cancer treatment for operable lesions in a low-resource contemporary setting

Background: To compare HIV+ and HIV- women with operable cervical cancer in a low resource contemporary setting. Methods: A retrospective study using well-matched controls from a Kenyan teaching and referral hospital. Results: 183 women were treated for cervical cancer between October 2007 and June 2011. The histologic subtype was squamous cell in all but one case. At presentation, 28 had operable lesions (Stage IA1–IIB1); 7 more received neoadjuvant chemotherapy prior to surgery. HIV seroprevalence was 54% (18/33) among initial operative cases and 57% among the neoadjuvant group (p=ns). Mean age was 42 (HIV+), and 43 (HIV-), (range 25-64). HIV- vs. HIV+ cervical cancer patients (mean CD4 count 373, 50%\u3c200) were detected by visual inspection with acetic acid (VIA) (18% (2/11)vs 68% (15/22) p=.099), symptoms (27%(3/11) vs 14%(3/22) p=.43), or Pap smear (45% (5/11) vs .09% (2/22) p=.06), respectively.HIV+ patients (two Stage IB1, two Stage IB2) did not require more downstaging than HIV- patients (two stage IIB, one stage IIIA) before surgery (18% (4/22) vs 27% (3/11) p=.63). Surgical treatments were not statistically different in either group and included radical hysterectomy(25), total abdominal hysterectomy(2), cesarean hysterectomy(1), and total vaginal hysterectomy(5). Postoperative complications included fever, dehiscence, DVT, ileus, fistula, and infectious complications (chest, urinary tract, wound). One HIV- patient suffered postoperative fever, vesicovaginal fistula, and wound dehiscence (overall complications .06%).Lymph node involvement was noted in 7 HIV+ and 3 HIV- patients who underwent full staging procedures (p=.004). Conclusions: In patients with operable cervical cancer, HIV serostatus does not affect complication rate or influence need for downstaging prior to surgery compared to a well-matched control group. HIV+ patients were not more likely to receive neoadjuvant chemotherapy but were more likely to have positive lymph nodes. VIA detected the majority of cervical cancers HIV+ patients

The evolution of comprehensive cancer care in Western Kenya

In the next 20 years, it is expected that 70% of incident cancers will be diagnosed in the developing world. There exist very few models of cancer care delivery in resource constrained settings. We present a model of cancer care delivery that developed as a result of a multi-institutional collaboration between high-income country academic medical centers and a Kenyan medical school and governmental referral hospital. Based on the infrastructure provided by a successful HIV care program, AMPATH-Oncology presently offers a range of clinical services across the continuum of care, including cervical cancer and breast cancer screening, palliative care, and oncology clinics in pediatric, adult, and gynecology oncology. This program grew from 346 patient visits amongst a few dozen patients in 2004 to over 30,000 visits by 2012 between screening programs and treatment programs. This paper describes the development of the program over a 7-year period

AMPATH-Oncology: A model for comprehensive cancer care in sub-Saharan Africa

Increased awareness of cancer as a health crisis facing less developed healthcare systems has led to recent calls for increased investment in cancer care infrastructure in low resource settings. However, operational descriptions of well-functioning cancer care systems in resource-constrained settings are limited. AMPATH-Oncology is the result of collaboration between North American, European, and Kenyan partners to develop a comprehensive cancer care model that supports screening services, cancer treatment, and palliative care. This article describes the approach taken by the AMPATH-Oncology program to deliver cancer care in a resource-constrained setting. A review of other ‘high-income – low-income’ collaborative models identifies successful strategies to implement cancer care in low resource environments

AMPATH-Oncology: A model for comprehensive cancer care in sub-Saharan Africa

AbstractIncreased awareness of cancer as a health crisis facing less developed healthcare systems has led to recent calls for increased investment in cancer care infrastructure in low resource settings. However, operational descriptions of well-functioning cancer care systems in resource-constrained settings are limited. AMPATH-Oncology is the result of collaboration between North American, European, and Kenyan partners to develop a comprehensive cancer care model that supports screening services, cancer treatment, and palliative care. This article describes the approach taken by the AMPATH-Oncology program to deliver cancer care in a resource-constrained setting. A review of other ‘high-income – low-income’ collaborative models identifies successful strategies to implement cancer care in low resource environments